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General NPI Number Information
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NPI Number | 1962091710
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Entity Type | Individual
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Provider Name | AUGUSTINA CHRISTINE DEFOE APN, MSN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 201 LYONS AVE STE L4
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-7205
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Fax | 973-923-8993
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Provider Business Mailing Address
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Address Line | 1041 SANFORD AVE APT 1
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City | IRVINGTON
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State | NJ
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Zip | 07111-5461
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Country | US
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Telephone | 862-218-8729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ01101400
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License Number State | NJ
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